Help Me Understand Obamacare

I need your help in understanding what Obamacare would mean for my family. Please note: I am NOT looking for political opinions. They abound, and I have my own. I’m actually looking for what this literally, practically, logistically means for my family.

Here’s our current situation. My husband’s income (not including my own which fluctuates dramatically) is about $475/week. My husband’s employer provides insurance. At about $350/week (yes WEEK not MONTH). Without telling you our actual expenses, but you can be assured that they are the same things that others pay… Rent, car insurance, utilities, food, gas, student loans, etc. We are frugal. Our truck is paid for (and 20 years old). We no longer use our credit cards, but we’re still paying one off. I coupon, use online deals, etc. Most of my clothes have holes in them, because I pay for clothes for my kids (with coupons) since they really are weeds in human disguise. In other words… We’re careful, methodical, and thoughtful with our money.

Income Approximate (as mine varies) per month: $3,500
Expenses:-$3,300
Remaining: $200 – currently put towards “extras” or extra debt, and when the debt is gone it’ll go into savings.

My kids, however, have serious medical and mental health issues. Aside from the annual/semi-annual dentist and pediatrician visit, one of my kids has an annual echocardiogram (about $1,500 a year), an electrocardiogram (about $500 a year), one of my kids has a monthly psychiatrist appointment (about $1,800 a year), and his meds ($900/month). So our medical costs NOT including regular well-child visits, OR sick kid visits, is $1,217/mo, $14,600/year. With the well child visits, vaccinations, and when they get sick, it’s obviously more. As a result, we use state subsidized medical insurance for the kids only. I do pay a premium for them, but it’s prorated based on our income. My husband and I haven’t seen a doctor, dentist, or ophthalmologist (I wear glasses), in about 4 years. We would go to the emergency room if we have to for something like a broken bone, or stitches, etc – but thank God we haven’t had to yet. It would probably bankrupt us. For everything else? We suffer. I’ve tried free clinics in our area, but it’s a first come/first served kind of thing to get an appointment, and I’ve yet to actually be able to talk to a real person to try and get an appointment. I kind of need to see a gynecologist desperately.

So. My understanding of Obamacare is… You are required to have health insurance. If you don’t, you pay taxes as a penalty. If you don’t have health insurance, you can use the government health insurance (which doesn’t exist yet). So my question is… Since it doesn’t exist, when do we start getting penalized? How much will the government health insurance cost? What will this (and when) look like for my family?

Again – I’m not looking for political opinions here. I’m looking for what this means, as it stands now, for my family. When I’ve looked into it, I’ve gotten totally confused. Does someone have a website that breaks it down into “real life” for you?

There are subsidies provided up to 400% of the federal poverty level, which is $23050 for a family of four. So, multiplying your monthly income by 12, it looks to be around $42000, or 180ish% of the federal poverty level. According to the site above, for 150-200% of the FPL, payments (required by you) begin at 4% and rise to 6.3% of income, so that would mean paying between $140 and $220 per month. The difference between the amount you are required to pay and the actual premium is provided as a tax credit.

“Individuals and families under 250 percent FPL (about $27,000 for an individual and $55,000 for a family of four) are also eligible for sliding scale cost-sharing credits. This, in addition to premium credits, will help defray any co-payments, co-insurance and deductibles. To get the cost-sharing credits, the individual has to enroll in a silver plan, and would then get assistance with the out-of-pocket expenses (meaning they would pay less than the average 30 percent of health care expenses) – so this would include your family.”

HOWEVER, it may also be the case that your husband’s job will change IT’S health insurance plan in response to Obamacare. So, under that, ‘affordable employer health insurance’ is considered 9.5% of income, or $332/month. If they make this change, you would be required to purchase the employer health care and wouldn’t be eligible for the exchange.

I do think this will all get worked out by January and hopefully be more clear then…good luck!!

Thank you for this! Frankly, as it stands now, we couldn’t afford the $332, but perhaps we could make it work with extra finagling and cutting back on the budget I could make it happen. Of course that means nothing for savings/uh-ohs, which sucks but there you go. Guess we’ll just have to see how it shakes out!

On an aside – if you’re in need of seeing a gynocologist, have you tried Planned Parenthood? They provide a variety of women’s health care on a sliding scale based on income (NOT just birth control, etc.).

Have you applied for Medicaid? My doctor said OUR family would qualify, because of our children’s special needs…he also suggested we look into Social Security benefits for the kids. I was like…umm…we’re okay. I mean…not that our kids aren’t expensive…b’cause they ARE. But, we squeak by. Any my hubby gets insurance through work. So…yeah…Medicaid. Look into it.